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<br /> File Original with DW R State of California DWR Use Only-Do Not Fill In
<br /> Page 1 of 2 Well Completion Report
<br /> Refer to Instruction Pamphlet State Well Number/Site Number
<br /> Owner's Well Number AMW-22 No. e0084069I N I I W
<br /> Oto Work Began 12/01/2008 Date Work Ended 12/3/2008 Latitude Lon nude
<br /> cal Permit Agency San Joaouin County
<br /> Permit Number SR#0055550 Permit Date 10/22/08 APN/TRS/Other
<br /> Geolois Lo Well Owner
<br /> Orientation E)Vertical 0Horizontal OAngle Specify Name Forward Incorporated
<br /> Drilling Method Mud Rotary Drilling Fluid Mud
<br /> Depth from Surface Description Mailing Address 9999 S.Austin Road
<br /> Feet to ,Feet" Describe material,2rain size,color,etc CitX Manteca State Chi 95336
<br /> 0.0 75.0 Not Sampled Well iocatiojnt:
<br /> 75.0 76.1 Sandy SILT,dry, hard, rust banding,fine grained Address in SE quadrant of NCYCC 2100'of newcastle Rd
<br /> sands,5 YR 5/6 City Stockton County San Joaquin
<br /> 76.1 80.0 Sandy SILT Latitude 37 53 30.14 N Longitude -121 11 41.4
<br /> 80.0 81.2 SAND&GRAVEL, med.sand thru coarse gravel, Dea. Min. Sec. Dea. Min. Sec.
<br /> sub-angular,well graded,wet, multi-colored Datum wcS84 Decimal Lat. 37.892 Decimal Long.-121.195
<br /> 81.2 81.5 SAND,fine-med.grained,some fine gravels, APN Book 181 Page 150 , Parcel 02,
<br /> dense,wet. 10 YR 5/4 Township 1 North Range=7 East Section 34
<br /> 81.5 85.0 SAND t-ocatidn Sketch Actittl
<br /> 85.0 85.6 Sandy SILT,slightly moist,very stiff, pyrite flakes, Sketch m6st be drawn by hand after,form is printedj, O New Well
<br /> North O Modification/Repair
<br /> organic inclusions, 10 YR 5/1
<br /> O Deepen
<br /> 85.6 90.0 Sandy SILT O Other
<br /> 90.0 90.7 Sandy SILT O DDeestroyedures and materials
<br /> 90.7 90.8 Silty CLAY,stiff,dry, 10 YR 5/4 under ceo ocic Loc
<br /> 90.8 95.0 Silty CLAY Planned.Uses
<br /> 95.0 95.8 SAND, med-coarse grained,well graded, multi- O Water Supply
<br /> colored, loose wet ❑Domestic ❑Public
<br /> ❑Irrigation ❑Industrial
<br /> 5.8 96.0 CLAY,with fine gravels,soft,wet, 10 YR 6/2 W
<br /> 196.0 96.5 SAND,fine-med.grained,slightly moisi,'med.soft O Cathodic Protection n
<br /> ® Dewatering
<br /> 10 YR 5/4 O Heat Exchange
<br /> 96.5 100.0 Clayey SILT O Injection
<br /> 100.0 101.3 Clayey SILT,dry, hard, 10 YR 5/4 0 Monitoring
<br /> 101.3 105.0 Clayey SILT O Remediation
<br /> 105.0 106.0 SAND,fine-med.grained,soft,wet,well-sorted, O Sparging
<br /> O Test Well
<br /> 5 YR 4/4 South
<br /> Illustrate or describe distance of well from roads,buildings,fences, O Vapor Extraction
<br /> 106.0 110.0 SAND rivers,etc and attach a map. Use additional paper if necessary. O Other
<br /> 110.0 111.0 SAND Please be accurate and com lata
<br /> 111.0 115.0 Sandy SILT
<br /> Water Level and Yield of Com feted Well
<br /> 115.0 115.4 Sandy SILT,stiff,fine grained, moist 10 YR 5/4 Depth to first water N/A (Feet below surface)
<br /> Depth to Static
<br /> Water Level 66.03 (Feet) Date Measured 12/08/2008
<br /> LTO,tt'a
<br /> epth of Boring 140 Feet***See Note Estimated Yield* N/A (GPM) Test Type N/A
<br /> epth ofCompleted Well 140 Feet at Bottom Test Length N/A (Hours)Total Drawdown N/A (Feet)
<br /> *May not be representative of a well's long term yield.
<br /> Casin sAnnular Materiel _
<br /> Depth from Borehole Wall Outside Screen Slot Size Depth from
<br /> Type Material
<br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description
<br /> Feet to Feet Inches Inches Inches Inches Feet to Feet
<br /> 0 119 8 Blank PVC Sch.80 0.218 2.375 N/A N/A 0 111 Cement Quickrete Concrete
<br /> 119 139 8 Screen PV Sch.80 0.218 2.375 PVC 0.010 111 115 Bentonite Pel-Plug Bentonite Pellets
<br /> 119 139 Sand 2/12 Cemex Lapis Lustre Sand
<br /> Attachments s - '` Certification Statement
<br /> ❑r Geologic Logue I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief
<br /> I] Well Construction Diagram Name Dave Vasbinder Herst&Assocites Inc
<br /> ❑ Geophysical LO S Person,Firm or Corporation
<br /> g( ) 4630 S. Hwy 94-N.Outer Road Saint Charles MO 63304
<br /> � Soil/Water Chemical Analyses Address City State zip
<br /> ❑ Other Signed �, S-a 636387
<br /> Attach additional information if it exists. C-57 Licensed Water Well Contractor Date Signed C-57 License Number
<br /> -Drilling depth scale begins at one foot above ground surface due to required drilling rig setup.
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